Guillén Gabriela, Martín-Giménez Marta Pilar, López-Fernández Sergio, Molino José Andrés, López Manuel
Pediatric Surgical Oncology Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
Department of Pediatric Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
J Laparoendosc Adv Surg Tech A. 2020 Apr;30(4):458-463. doi: 10.1089/lap.2019.0515. Epub 2020 Feb 3.
Laparoscopy is widely accepted for the surgical treatment of benign ovarian lesions in adult women, with results similar to an open approach when spillage is avoided by different means such as endobag retrieval. This approach is controversial in children. Retrospective study (2009-2018) of all pediatric ovarian tumors with histological confirmation treated in a tertiary center. Data regarding preoperative selection criteria, surgical technique, and follow-up were registered. Laparoscopy was used only in tumors without malignant features and whose size allowed retrieving them through a small incision without morcellating. Emphasis was set in ovarian sparing surgery (OSS), comparing the results of open (OP) and laparoscopic (LPC) approach. During the study period, 48 suspicious lesions in 45 patients were operated. Thirty cases (32 tumors) showed benign features (10 cystadenomas, 14 mature teratomas, 6 nontumor lesions); treatment consisted in oophorectomy in 13 (OP 6, LPC 7) and OSS in 17 (OP 5, LPC 12). There was one conversion in the LPC group. Mean follow-up was 3.44 years (range 0.03-8.84), based on annual ultrasound (US) and tumor markers during at least 5 years, recommending a lifetime follow-up by a gynecologist. There was only one relapse in a laparoscopically enucleated cystadenoma, and 2 patients developed contralateral metacronous teratomas. No procedure-related complications happened. Our series, although small and with a limited follow-up, suggest that laparoscopy could be an option of treatment in a subset of highly selected patients, although laparotomy remains the gold standard approach if malignancy is suspected.
腹腔镜检查已被广泛接受用于成年女性良性卵巢病变的外科治疗，当通过不同方法（如使用内袋取出术）避免腹腔内容物溢出时，其效果与开放手术相似。但这种方法在儿童中存在争议。对某三级医疗中心在2009年至2018年期间治疗的所有经组织学确诊的小儿卵巢肿瘤进行回顾性研究。记录了有关术前选择标准、手术技术和随访的数据。腹腔镜检查仅用于无恶性特征且大小允许通过小切口取出而无需切碎的肿瘤。重点在于卵巢保留手术（OSS），比较开放手术（OP）和腹腔镜手术（LPC）的结果。在研究期间，对45例患者的48个可疑病变进行了手术。30例（32个肿瘤）表现为良性特征（10例囊腺瘤、14例成熟畸胎瘤、6例非肿瘤性病变）；13例（OP组6例，LPC组7例）采用卵巢切除术，17例（OP组5例，LPC组12例）采用OSS。LPC组有1例中转开腹。平均随访时间为3.44年（范围0.03 - 8.84年），至少5年内每年进行超声（US）检查和肿瘤标志物检测，并建议由妇科医生进行终身随访。腹腔镜下摘除的囊腺瘤仅1例复发，2例患者出现对侧异时性畸胎瘤。未发生与手术相关的并发症。我们的系列研究虽然样本量小且随访有限，但表明腹腔镜检查对于一部分经过严格筛选的患者可能是一种治疗选择，不过如果怀疑有恶性肿瘤，剖腹手术仍然是金标准方法。
